Utilizing a Tailored Approach to Standardized Screening of Health-Related Social Needs.

BACKGROUND: Despite the increased awareness of social determinants of health (SDoH), integrating social needs screening into health care practice has not consistently occurred. LOCAL PROBLEM: No social needs screening using recommended standardized questions was available at an outpatient hemodialysis clinic. METHODS: Plan-Do-Study-Act cycles, based on the Model for Improvement, were used to implement the Core 5 SDoH screening tool, a staff referral process, and an evaluation of the implementation process. INTERVENTION: A standardized social needs screening tool and a staff referral process were implemented. An evaluation of the implementation process also occurred. RESULTS: Of 73 patients screened, 21 reported 32 unmet social needs; all received referrals to community resources. Nurses demonstrated high acceptance and usability of the tool and the referral process. CONCLUSIONS: Implementing a standardized screening and referral process customized to clinical workflow enhanced the identification of social needs in patients undergoing hemodialysis.

Choosing Wisely in Critical Care: A National Survey of Critical Care Nurses.

BACKGROUND: To promote the use of appropriate testing, and decrease unnecessary treatments, the ABIM Foundation established the Choosing Wisely campaign in 2012. Initially targeting physicians, the campaign has evolved to encourage all providers to promote high-value care; however, information related to critical care nursing is limited. OBJECTIVES: To assess nurses' reports of the use of Choosing Wisely recommendations in critical care settings. METHODS: Responses from nurses were examined as part of a critical care survey of members of 4 societies in order to assess awareness and use of the Choosing Wisely recommendations. RESULTS: Of the 1651 acute and critical care nurses who were members of the American Association of Critical-Care Nurses and responded to the survey, 632 (38.3%) reported being familiar with the Choosing Wisely campaign. Of these respondents, 200 identified as advanced practice nurses. A total of 620 reported implementing the 5 Critical Care Society Collaborative recommendations, including reducing diagnostic testing (n = 311 [50.2%]), reducing the number of red blood cell transfusions (n = 530 [85.5%]), not using parenteral nutrition in adequately nourished patients (n = 293 [47.3%]), not using deep sedation in patients receiving mechanical ventilation (n = 499 [80.5%]), and offering comfort care for patients at high risk for death (n = 416 [67.1%]). Staff education, specific protocols, electronic medical record alerts, and order sets all raised nurses' awareness of the recommendations. CONCLUSIONS: Acute and critical care nurses are directly involved with measures to reduce unnecessary testing and treatments. Greater awareness and championing of the Choosing Wisely recommendations by acute and critical care nurses can help to promote high-value care for acute and critically ill patients.

Providing a "good death" for oncology patients during the final hours of life in the intensive care unit.

Cancer is a leading cause of death in the United States. Aggressiveness of cancer care continues to rise in parallel with scientific discoveries in the treatment of a variety of malignancies. As a result, patients with cancer often require care in intensive care units (ICUs). Although growth in hospice and palliative care programs has occurred nationwide, access to these programs varies by geographic region and hospital type. Thus, critical care nurses may be caring for patients with cancer during the final hours of life in the ICU without the support of palliative care experts. This article provides an overview of the meaning of the final hours of life for cancer patients and uses principles of a "good death" and the tenets of hospice care to organize recommendations for critical care nurses for providing high quality end-of-life care to patients with cancer in the ICU.

The meaning of our work: caring for the critically ill patient with cancer.

The prevalence and survival rates of critically ill patients with cancer in the intensive care unit have increased considerably in the past 2 decades; yet, the meaning of caring for cancer patients in this setting may fall along a continuum. This article addresses the nurse's experience in caring for the critically ill patient with cancer by presenting a current profile of these patient in the intensive care unit in the context of the historical development and mission of critical care and the evolution of cancer as a chronic disease. The moral distress that can result when these 2 "cultures" or "realities" collide and the meaning of the nurse's work will be examined. Strategies and resources for critical care nurses to incorporate into their practice when caring for the critically ill patient with cancer, and themselves, will be addressed.

Patterns of community-based end-of-life care in rural areas of the United States.

There is relatively little empirical data on the supply of community-based end-of-life (EOL) providers especially in rural areas despite projections for growth. This study examined the availability of community-based EOL providers in eight states using mapping techniques and statistical approaches. Analysis of variance and geographic information system approaches were used to compare the availability of community-based EOL providers at the county level by degree of rurality. Examining numbers of rural counties by provider, it was found that hospices were the least available community-based EOL providers in rural counties with 62% to 92% of rural counties not having hospice providers (exception: Vermont). When examining the number of providers by population older than 65 years, few differences were found. It is concluded that there are substantially fewer hospice providers in the most rural areas, raising issues of access to care. Examination of both unadjusted and adjusted numbers of providers is important to understand community-based EOL provider supply.